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Gastroesophageal Reflux Disease (GERD): Back to Surgery?
  1. W J OWEN

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Gastroesophageal Reflux Disease (GERD): Back to Surgery? Edited by Buchler MW, Frei E, Klaiber C, Krahenbuhl L. (Pp 248; illustrated: $184.00.) Basel: Karger, 1996. ISBN 3-8055-6476-7.

Gastro-oesophageal reflux disease (GORD) can now rightly be regarded as the English disease as its prevalence here exceeds that any of any other country.

This book is a response to the “swelling chorus of acclamation” relating to the place of minimally invasive surgery for the treatment of this condition and actually has a great deal to offer for anyone involved in the management of reflux patients.

In the 32 short essays there are some very important and highly relevant questions about GORD and an attempt to answer them. It is sometimes reassuring to know that despite a very informed discussion and sound reasoning, even the experts have uncertainties about, for example, Barrett’s surveillance and how to manage the very exciting concept of the ultra-short Barrett’s oesophagus.

The reappraisal of the diagnostic assessment of GORD is both timely and very helpful. Any attempt to abolish “equivocal oesophagitis” and to reduce the interobserver variation in this rather important and specific finding is, of course, welcome. There is no doubt that the major parts of the book are about when, how and who should do a “lapwrap”. We are told that from the health economics point of view there is a break even point at six years when one compares a laparoscopic Nissen versus long term omeprazole. When one considers an open Nissen this break even point is not reached for 10 years. On the other hand in the USA, despite the existence of 40 000 Board Certified Surgeons there are probably only a small group of suitably trained surgical experts who can safely perform a laparoscopic fundoplication.

Several of the chapters debate the technical details of laparoscopic anti-reflux surgery and the surgeons will certainly welcome the discussions about the importance of mobilising short gastric vessels, the use of a Bougie, the length of the wrap as well as the place of a partial (Toupet) fundoplication. This book will also find a very welcome place with those who occasionally have to manage those unfortunate dysphagic patients after surgery and hopefully will approve the recommendation of a wait and see policy. A very sensible algorithm is presented for coping with this rather distressing complication. Perhaps an equally complexing problem are those with recurrent reflux after surgery, and it is particularly refreshing to have a frank discussion about the management of this group, emphasising the potential morbidity and even mortality of surgery in this particular scenario.

This book is about wrap versus zap. It is highly informative, at times entertaining, and will be of great value to those who are either in or hovering on the edge of the expanding field of laparoscopic anti-reflux surgery.